Introduction

Article Outline

• The Bicuspid Aortic Valve: Differentiated and Segmental Approaches to Repair
• Tetralogy of Fallot with Absent Pulmonary Valve
• Lung Transplantation: Cadaveric and Living-Related
• Copyright

Operative Techniques in Thoracic and Cardiovascular Surgery has thrived under the editorial leadership of Dr. Lawrence Cohn since January 2004. He has been ably assisted by Associate Editors Dr. Thoralf Sundt (Adult Cardiac Surgery), Dr. Richard Jonas (Congenital Heart Surgery), and Dr. Steven Mentzer (General Thoracic Surgery). This group has made significant innovations in Operative Techniques and has contributed materially to its success.

This issue marks a change in leadership for the Journal. Dr. Cohn, in anticipation of becoming Editor of The Journal of Thoracic and Cardiovascular Surgery January 1, 2008, resigned as Editor of Operative Techniques. I succeeded him as Editor of Operative Techniques, effective January 1, 2007. Dr. Thoralf Sundt will remain as Associate Editor for Adult Cardiac Surgery; he is joined by Dr. David Jones as Associate Editor for General Thoracic Surgery and by Dr. Scott Bradley as Associate Editor for Congenital Heart Surgery. The new editorial staff would like to acknowledge the significant contributions of the previous staff, and we pledge to continue to improve this outstanding journal.

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The Bicuspid Aortic Valve: Differentiated and Segmental Approaches to Repair 

The great appeal of reconstructive over replacement approaches to valvular heart disease is evidenced by the widespread acceptance of mitral valve repair as the standard of care for degenerative mitral insufficiency and by the growing interest in valve-sparing root reconstruction. Although repair of the aortic valve has, in the past, been less reliable than that of the mitral valve, a small number of stalwart enthusiasts have persisted in this endeavor and are reporting increasingly satisfactory results, particularly in the case of bicuspid aortic valve disease. Two such individuals have contributed to this issue of Operative Techniques. Joachim Schäfers has had a decade-long interest in repair of bicuspid disease and experience that has led to what he calls a “differentiated approach” to reconstruction of the valve. Gosta Pettersson has based his “segmental approach” on analysis of the cusps, commissures, and root anatomy. Together these two experienced surgeons provide clear descriptions of their techniques, which readers should be able to apply in their own practices.

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Tetralogy of Fallot with Absent Pulmonary Valve 

This condition is a rare variant of tetralogy of Fallot characterized by marked dilation of the central pulmonary arteries. This “syndrome” can be associated with airway abnormalities including severe, diffuse bronchomalacia and stenosis. Surgical treatment of young infants presenting with respiratory failure remains a significant challenge with a high mortality rate. Points of controversy in the surgical approach include the need for a competent pulmonary valve, reduction-plasty of the pulmonary arteries, complete replacement of the central pulmonary arteries, and use of a Lecompte maneuver. Drs. Welke and Ungerleider from Oregon Health Science University in Portland illustrate an approach that replaces the central pulmonary arteries with a valved homograft conduit. Dr. Hraska from the Asklepios Clinic, St. Augustin, Germany, presents the use of anterior translocation of the pulmonary arteries, an approach he pioneered. These two articles provide excellent illustrations of the surgical options available for this defect.

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Lung Transplantation: Cadaveric and Living-Related 

Over the past 25 years, lung transplantation has evolved into a relatively common procedure, although it remains one of the more technically challenging procedures that thoracic surgeons perform. With this evolution has come an increased demand for the procedure by patients with a variety of end-stage lung diseases, such that alternatives to cadaveric lung donors are now actively being pursued. In this issue, Mark Barr and colleagues from the University of Southern California report on their technique of performing living-related lobar transplants. This group has one of the world’s largest series with this procedure, and their description of the technique is particularly well illustrated and described in detail. In the companion article, Duane Davis from Duke University shares his approach to cadaveric lung transplantation, focusing on the important technical considerations involved in bilateral lung transplantation. The group at Duke has built one of the premier lung transplant programs in the country; their article provides the reader with a splendid technical overview of how to perform this demanding procedure.